Fenofibrate/simvastatin fixed-dose combination in the treatment of mixed dyslipidemia: safety, efficacy, and place in therapy.

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Term Occurence Count Dictionary
diabetes mellitus 2 endocrinologydiseases
diabetic retinopathy 2 endocrinologydiseases
familial combined hyperlipidemia 1 endocrinologydiseases
gemfibrozil 2 endocrinologydiseasesdrugs
metabolic syndrome 4 endocrinologydiseases
pravastatin 1 endocrinologydiseasesdrugs
atorvastatin 3 endocrinologydiseasesdrugs
bezafibrate 1 endocrinologydiseasesdrugs
obesity 2 endocrinologydiseases
simvastatin 41 endocrinologydiseasesdrugs
fenofibrate 48 endocrinologydiseasesdrugs
hyperlipidemia 1 endocrinologydiseases
hypertriglyceridemia 2 endocrinologydiseases
hypothyroidism 4 endocrinologydiseases
rosuvastatin 1 endocrinologydiseasesdrugs

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Select Drug Character Offset Drug Term Instance
atorvastatin 8214 in large trials. Single study observation reports that simvastatin is able to increase HDL more than atorvastatin .[32] Statins are able to stabilize atherosclerotic plaque, and simvastatin has provided evidence of
atorvastatin 10476 simvastatin might exhibit a superior antidepressant effect in post-CABG-treated patients compared to atorvastatin and be a promising coadjuvant agent in oncology.[42],[43]FenofibrateFenofibrate is a pro-drug transformed
atorvastatin 28121 fenofibrate with other statinsThe addition of fenofibrate has been tested with other statins (fluvastatin, atorvastatin , pravastatin, and rosuvastatin) in comparison with monotherapy, with overall favorable results and comparable
bezafibrate 27859 rhabdomyolysis) as evaluated in a retrospective analysis.[90] Safety and efficacy about combination of bezafibrate with simvastatin, even if positive, are based only on two single experiences with poor sample sizes
fenofibrate 1066 issue. In this review, the effect and safety of an approved combination therapy with simvastatin plus fenofibrate are described, with an analysis of pros and cons resulting from randomized multicenter trials, meta-analyses,
fenofibrate 3551 conclusive. Among the many possible and existing combinations, the most widely used is simvastatin plus fenofibrate . Nevertheless, the real and net benefit of this specific pharmacological association is still debated.Other
fenofibrate 4093 “adverse effects, cardiovascular disease, combined dyslipidemia, diabetes mellitus, dyslipidemia, fenofibrate , fenofibric acid, fibrate, mixed dyslipidemia, lipid-lowering medications, simvastatin, simvastatin
fenofibrate 4209 fenofibric acid, fibrate, mixed dyslipidemia, lipid-lowering medications, simvastatin, simvastatin and fenofibrate , statin, statin and fibrate.” After a thorough search, the most relevant randomized clinical trials
fenofibrate 11367 acetyl-CoA-carboxylase, fatty acids synthase, and ApoB under-expression. Furthermore, fibrates, particularly fenofibrate , reduce LDL and increase size and density of sd-LDL; also, Lp-PLA1 (lipoprotein – phospholipase A1)
fenofibrate 12355 shift to less-buoyant LDL particles.[44]Weak results were obtained in glucose control: in some studies, fenofibrate improved insulin sensitivity and glucose level in metabolic syndrome, DM2 and CD patients.[49]–[52]
fenofibrate 12646 sensitizer) in adipose tissue.[53]Also, other studies showed antithrombotic and fibrinolytic properties of fenofibrate (decrease in PAI and fibrinogen),[54] neo-angiogenesis reduction, and, on the other side, increase of
fenofibrate 13082 [TNF-α]), adhesion molecules (VCAM and ICAM) and uric acid were reduced with the administration of fenofibrate in a high-risk group.[52]–[54]On account of what stated, two main trials have been carried out with
fenofibrate 13257 main trials have been carried out with regard to real clinical efficacy of lipid-lowering effect of fenofibrate and both investigated the efficacy in DM2 population because of frequent incidence of CD with DM.The
fenofibrate 13645 fifth had previous diagnosis of CHD.[55] The comparison with placebo did not result in superiority of fenofibrate 200 mg/day in terms of primary composite outcomes (CHD events); however, while failed to present minor
fenofibrate 13798 outcomes (CHD events); however, while failed to present minor rates of CHD mortality significantly, fenofibrate -treated group showed a reduction in nonfatal myocardial infarction (hazard ratio, HR: 0.76). Total mortality,
fenofibrate 13992 HR: 0.76). Total mortality, total stroke, and total CVD mortality reduced nonsignificantly, whereas fenofibrate decreased the incidence of coronary revascularization and first minor amputation as well as delayed
fenofibrate 14232 retinopathy or maculopathy (present only in 8% of baseline sample). Apparently, the lack of efficacy of fenofibrate compared to placebo should be related to higher number of randomized placebo patients who were already
fenofibrate 14643 affected by marked hypertriglyceridemia, CD, and metabolic syndrome experienced greater benefit of fenofibrate treatment.[56] Unexpectedly, fenofibrate slowered glomerular filtration rate (GFR) decline and reduced
fenofibrate 14684 CD, and metabolic syndrome experienced greater benefit of fenofibrate treatment.[56] Unexpectedly, fenofibrate slowered glomerular filtration rate (GFR) decline and reduced albuminuria rate.[44]The DAIS trial (Diabetes
fenofibrate 14918 Atherosclerosis Intervention Study) was designed to demonstrate a slower CHD progression in subjects treated with fenofibrate compared to placebo group.[57] Although the ambitious endpoint was not satisfied, due to diffuse disease,
fenofibrate 15103 satisfied, due to diffuse disease, minimum lumen diameter of focal atherosclerosis appeared higher in fenofibrate recipients, however, similarly to FIELD, fenofibrate decreased albuminuria rate.Combination therapyEfficacyThe
fenofibrate 15156 diameter of focal atherosclerosis appeared higher in fenofibrate recipients, however, similarly to FIELD, fenofibrate decreased albuminuria rate.Combination therapyEfficacyThe ACCORD Lipid, a double-blind, randomized,
fenofibrate 15321 therapyEfficacyThe ACCORD Lipid, a double-blind, randomized, open-label trial, aimed to verify the superiority of fenofibrate plus simvastatin versus placebo plus simvastatin in 5518 patients with DM2 at high risk of CVD.[58]
fenofibrate 16341 which assessed subjects with diabetic retinopathy.[60] As previously demonstrated in the FIELD,[55] fenofibrate in combination therapy showed its protective effect with regard to this common complication with a substantial
fenofibrate 16654 observations that post-prandial TGs are predictors of CHD,[62],[63] investigated the supposed superiority of fenofibrate plus simvastatin in lowering non-fasting TG compared to placebo associated with simvastatin: the hypothesis
fenofibrate 16981 in subject with high fasting TG at the baseline.According to SAFARI trial (study of simvastatin plus fenofibrate for combined hyper-lipidemia), simvastatin 20 mg plus fenofibrate 160 mg improved the overall lipid
fenofibrate 17047 trial (study of simvastatin plus fenofibrate for combined hyper-lipidemia), simvastatin 20 mg plus fenofibrate 160 mg improved the overall lipid profile:[64] in particular, while HDL almost doubled, TGs were reduced
fenofibrate 17257 reduced by 43% in the combination treatment group. Moreover, as previously reported, the addition of fenofibrate caused a shift to larger, buoyant, and less dangerous LDL particles.In a post hoc analysis, the same
fenofibrate 17765 studies supported existing data with regard to lipid profile: Mohiuddin et al[66] used the lowest dose of fenofibrate than the other studies did (135 vs 160 mg in the SAFARI and 200 mg in the ACCORD) associated with simvastatin
fenofibrate 18091 TG decreased drastically (−37.4% vs −14.2%). Percentages approximately equivalent were found in fenofibrate 135 mg plus simvastatin 40 mg.The DIACOR (Diabetes and Combined Lipid Therapy Regimen) study compared
fenofibrate 18353 results showed that the supplemental advantage in HDL rise and TG decrease are derived merely from fenofibrate addition.[67] Furthermore, an analysis from DIACOR study confirmed positive modifications found during
fenofibrate 18679 groups treated with different double-drug combinations (from simvastatin 10 mg to simvastatin 30 mg plus fenofibrate 200–300 mg) showed improvement in lipid profile, albeit the more statistically significant overall
fenofibrate 18836 profile, albeit the more statistically significant overall benefit was obtained with simvastatin 20 mg/ fenofibrate 200 mg, and no serious adverse reactions were noted in any group.[69] If slight differences among various
fenofibrate 19156 and alternate day use.[70] Outstanding results can be obtained with a new fixed-dose combination with fenofibrate 145 mg in a new nanotechnology formulation compared to single medications.[71] As observable from all
fenofibrate 19655 to achieve a substantial cholesterol reduction. A mild, direct, nonsignificant correlation between fenofibrate dosage and total cholesterol reduction is also evident (linear weighted regression analysis).Pleiotropic
fenofibrate 19994 fibrinogen after 3 months of treatment for an acute coronary syndrome, and this is attributed mainly to fenofibrate addition.[72],[73] Nevertheless, clinical validations are still expected.An analysis carried out on
fenofibrate 20189 analysis carried out on animals fed with high fat content diet and treated separately with simvastatin and fenofibrate compared to untreated controls provided preliminary results with regard to metabolomic effects: aside
fenofibrate 20797 used in humans, and these data require further confirmations.Administered together, simvastatin and fenofibrate potentiate their own anti-inflammatory properties in DM2 patients, as proven by a decrease in a greater
fenofibrate 22307 dysfunction induced by fibrate, as shown in animal models which were treated with both potent and weak ( fenofibrate ) compounds;[80],[81] however, experimental doses are extremely higher than those used in humans. Similar
fenofibrate 23213 increase statin half-life therefore augmenting the risk of statin side effects. Gemfibrozil, but not fenofibrate , inhibits OATP1B1 (organic anion-transporting polypeptide), a cellular transporter from blood stream
fenofibrate 23507 thus this association should be avoided.[85]When combined, both in fixed dose and in staggered dose, fenofibrate decreases simvastatin AUC (area under the plasma concentration curve) by ~30%, as reported in two isolated
fenofibrate 25303 Additionally, absolute number of deaths was definitely comparable between the two groups (203 in the fenofibrate plus simvastatin group vs 221 in placebo). Overall risk of myotoxicity was very low in combination therapy,
fenofibrate 27716 while, generally, the combination with gemfibrozil is associated with higher rates of DAEs compared to fenofibrate (ie, 15 vs 20.7/100,000 for rhabdomyolysis) as evaluated in a retrospective analysis.[90] Safety and
fenofibrate 28014 based only on two single experiences with poor sample sizes and brief follow-up.[91],[92]Comparison of fenofibrate with other statinsThe addition of fenofibrate has been tested with other statins (fluvastatin, atorvastatin,
fenofibrate 28060 sample sizes and brief follow-up.[91],[92]Comparison of fenofibrate with other statinsThe addition of fenofibrate has been tested with other statins (fluvastatin, atorvastatin, pravastatin, and rosuvastatin) in comparison
fenofibrate 28921 treatment indications. Although not superior to placebo in reducing major CV events, the addition of fenofibrate to lipid-lowering therapy in DM2 patients has a series of healthy effects on endothelial function, inflammation,
fenofibrate 30588 medications should be considered. Association therapy is not reported; nevertheless, simvastatin and fenofibrate alone have shown to be useful.[102],[103] Since the risk of muscular toxicity is increased and numerous
fenofibrate 31361 dyslipidemia stimulating lipogenesis.[108],[109] Double therapy is a reliable option for dyslipidemia: indeed, fenofibrate is very effective also in HIV patients;[110] however, simvastatin is contraindicated in case of protease
fenofibrate 33380 dual lipid-lowering therapy constitutes a viable solution. Combination therapy with simvastatin and fenofibrate , in various dosages, is an efficient and reliable mean of pharmacological prevention as large, multicenter,
fenofibrate 35421 (?),Warfarin, ErythromycinTable 2ACCORD LIPID and EYE TRIAL outcomes[58],[60]EndpointSimvastatin + fenofibrate (N)Simvastatin + placebo (N)Hazard ratio (p-value)Primary outcomesMajor CV event (nonfatal MI, nonfatal
fenofibrate 36814 lipid lowering response and according to international guidelines (overall average dose was 22.3 mg in fenofibrate group);§fenofibrate 54 mg was administered in patients with baseline or incidental eGFR <50 mL/min/1.73
fenofibrate 36835 and according to international guidelines (overall average dose was 22.3 mg in fenofibrate group);§ fenofibrate 54 mg was administered in patients with baseline or incidental eGFR <50 mL/min/1.73 m2;§§data refer
gemfibrozil 27512 be monitored periodically in any case.Comparison of simvastatin with other fibratesSimvastatin plus gemfibrozil have an evidently high risk/benefit ratio because of clear pharmacological interactions, while, generally,
gemfibrozil 27652 risk/benefit ratio because of clear pharmacological interactions, while, generally, the combination with gemfibrozil is associated with higher rates of DAEs compared to fenofibrate (ie, 15 vs 20.7/100,000 for rhabdomyolysis)
pravastatin 28135 other statinsThe addition of fenofibrate has been tested with other statins (fluvastatin, atorvastatin, pravastatin , and rosuvastatin) in comparison with monotherapy, with overall favorable results and comparable safety
rosuvastatin 28152 addition of fenofibrate has been tested with other statins (fluvastatin, atorvastatin, pravastatin, and rosuvastatin ) in comparison with monotherapy, with overall favorable results and comparable safety profile among
simvastatin 54 Title: Vascular Health and Risk ManagementFenofibrate/ simvastatin fixed-dose combination in the treatment of mixed dyslipidemia: safety, efficacy, and place in therapyNicola
simvastatin 1049 is a concerning issue. In this review, the effect and safety of an approved combination therapy with simvastatin plus fenofibrate are described, with an analysis of pros and cons resulting from randomized multicenter
simvastatin 3534 monotherapy are not conclusive. Among the many possible and existing combinations, the most widely used is simvastatin plus fenofibrate. Nevertheless, the real and net benefit of this specific pharmacological association
simvastatin 4180 dyslipidemia, fenofibrate, fenofibric acid, fibrate, mixed dyslipidemia, lipid-lowering medications, simvastatin , simvastatin and fenofibrate, statin, statin and fibrate.” After a thorough search, the most relevant
simvastatin 4193 fenofibrate, fenofibric acid, fibrate, mixed dyslipidemia, lipid-lowering medications, simvastatin, simvastatin and fenofibrate, statin, statin and fibrate.” After a thorough search, the most relevant randomized
simvastatin 8168 mg).[28]–[31]Simvastatin reduces CV risk as confirmed in large trials. Single study observation reports that simvastatin is able to increase HDL more than atorvastatin.[32] Statins are able to stabilize atherosclerotic plaque,
simvastatin 8290 increase HDL more than atorvastatin.[32] Statins are able to stabilize atherosclerotic plaque, and simvastatin has provided evidence of its important contribute.[33],[34] Furthermore it can, independently from dosages,
simvastatin 8742 that cardiovascular risk mortality was reduced by 42% because of the daily dosage of 20–40 mg of simvastatin over a 5-year long period and myocardial revascularization risk decreased by 37%. Moreover, cerebrovascular
simvastatin 9020 to about a third.The Heart Protection Study,[39] a larger trial, demonstrated the evident benefit of simvastatin 40 mg in high-risk population (previous CV events, DM1 and DM2, hypertension): as primary endpoint mortality
simvastatin 9665 compared to previous angiograms, and, in addition, a slowed progression of CHD in the group treated with simvastatin 20 mg/day compared to placebo recipients.[40]As described, simvastatin plays a chief role as lipid-lowering
simvastatin 9736 CHD in the group treated with simvastatin 20 mg/day compared to placebo recipients.[40]As described, simvastatin plays a chief role as lipid-lowering medication in terms of primary and secondary prevention of the
simvastatin 10032 in combination therapy with fibrates.Even though high dosages of the most potent statins, including simvastatin , are related to an increased risk of new onset diabetes, a meta-analysis concluded that the potential
simvastatin 10229 that the potential risk is outright balanced from the real clinical benefit of statins.[41] Moreover, simvastatin , as typical of its class, is characterized by several pleiotropic effects on different organs and systems:
simvastatin 10375 characterized by several pleiotropic effects on different organs and systems: according to some reports, simvastatin might exhibit a superior antidepressant effect in post-CABG-treated patients compared to atorvastatin
simvastatin 15338 Lipid, a double-blind, randomized, open-label trial, aimed to verify the superiority of fenofibrate plus simvastatin versus placebo plus simvastatin in 5518 patients with DM2 at high risk of CVD.[58] The final results
simvastatin 15370 open-label trial, aimed to verify the superiority of fenofibrate plus simvastatin versus placebo plus simvastatin in 5518 patients with DM2 at high risk of CVD.[58] The final results showed no significant variations
simvastatin 16671 post-prandial TGs are predictors of CHD,[62],[63] investigated the supposed superiority of fenofibrate plus simvastatin in lowering non-fasting TG compared to placebo associated with simvastatin: the hypothesis was rejected,
simvastatin 16746 superiority of fenofibrate plus simvastatin in lowering non-fasting TG compared to placebo associated with simvastatin : the hypothesis was rejected, but, however, Apo-B48, marker of postprandial chylomicrons, was reduced
simvastatin 16964 greater extent in subject with high fasting TG at the baseline.According to SAFARI trial (study of simvastatin plus fenofibrate for combined hyper-lipidemia), simvastatin 20 mg plus fenofibrate 160 mg improved the
simvastatin 17024 baseline.According to SAFARI trial (study of simvastatin plus fenofibrate for combined hyper-lipidemia), simvastatin 20 mg plus fenofibrate 160 mg improved the overall lipid profile:[64] in particular, while HDL almost
simvastatin 17875 fenofibrate than the other studies did (135 vs 160 mg in the SAFARI and 200 mg in the ACCORD) associated with simvastatin 20 and obtained favorable results in comparison with statin alone: HDL-C increased (+17.8% vs 7.2%)
simvastatin 18115 (−37.4% vs −14.2%). Percentages approximately equivalent were found in fenofibrate 135 mg plus simvastatin 40 mg.The DIACOR (Diabetes and Combined Lipid Therapy Regimen) study compared the combination therapy
simvastatin 18635 reached consistent conclusions: all four groups treated with different double-drug combinations (from simvastatin 10 mg to simvastatin 30 mg plus fenofibrate 200–300 mg) showed improvement in lipid profile, albeit
simvastatin 18656 conclusions: all four groups treated with different double-drug combinations (from simvastatin 10 mg to simvastatin 30 mg plus fenofibrate 200–300 mg) showed improvement in lipid profile, albeit the more statistically
simvastatin 18818 improvement in lipid profile, albeit the more statistically significant overall benefit was obtained with simvastatin 20 mg/fenofibrate 200 mg, and no serious adverse reactions were noted in any group.[69] If slight differences
simvastatin 20173 expected.An analysis carried out on animals fed with high fat content diet and treated separately with simvastatin and fenofibrate compared to untreated controls provided preliminary results with regard to metabolomic
simvastatin 20781 those generally used in humans, and these data require further confirmations.Administered together, simvastatin and fenofibrate potentiate their own anti-inflammatory properties in DM2 patients, as proven by a decrease
simvastatin 23355 anion-transporting polypeptide), a cellular transporter from blood stream to hepatic cells, increasing simvastatin concentration and its adverse effects; thus this association should be avoided.[85]When combined, both
simvastatin 23529 should be avoided.[85]When combined, both in fixed dose and in staggered dose, fenofibrate decreases simvastatin AUC (area under the plasma concentration curve) by ~30%, as reported in two isolated studies, while
simvastatin 23641 AUC (area under the plasma concentration curve) by ~30%, as reported in two isolated studies, while simvastatin acid was not affected.[86] Many pharmacological mechanisms have been postulated; however, since the
simvastatin 24793 (myopathy, myositis, and rhabdomyolysis) in the treatment group was equally balanced to placebo plus simvastatin recipients (0.1% for both).[58] Although nephroprotective effect resulted in long term, fibrate co-administration
simvastatin 25320 absolute number of deaths was definitely comparable between the two groups (203 in the fenofibrate plus simvastatin group vs 221 in placebo). Overall risk of myotoxicity was very low in combination therapy, including
simvastatin 26448 interstitial lung disease, have been described in sporadic cases. Obviously, new onset diabetes related to simvastatin could not be evaluated in these statistics because diabetes was a chief inclusion criterion.Finally,
simvastatin 26951 dosage of statins and other toxic drugs whose interferences may be harmful (almost exclusively for simvastatin ) or with preexisting risk factors (chronic kidney disease, hepatic insufficiency, muscular disease,
simvastatin 27464 insufficiency.[89] Transaminases and CPK should be monitored periodically in any case.Comparison of simvastatin with other fibratesSimvastatin plus gemfibrozil have an evidently high risk/benefit ratio because of
simvastatin 27876 evaluated in a retrospective analysis.[90] Safety and efficacy about combination of bezafibrate with simvastatin , even if positive, are based only on two single experiences with poor sample sizes and brief follow-up.[91],[92]Comparison
simvastatin 30572 lipid-lowering medications should be considered. Association therapy is not reported; nevertheless, simvastatin and fenofibrate alone have shown to be useful.[102],[103] Since the risk of muscular toxicity is increased
simvastatin 31427 option for dyslipidemia: indeed, fenofibrate is very effective also in HIV patients;[110] however, simvastatin is contraindicated in case of protease inhibitors treatment, which could elevate simvastatin concentration
simvastatin 31520 however, simvastatin is contraindicated in case of protease inhibitors treatment, which could elevate simvastatin concentration by 10 times and increase the risk of overexposure via CYP3A4 inhibition.[111],[112] Therefore,
simvastatin 32486 high, medication should be considered, preferentially in children aged >10 years.[113] Low dose of simvastatin alone has demonstrated to improve vascular reactivity in children with FH and to be effective and safe
simvastatin 33364 efficacy; therefore, dual lipid-lowering therapy constitutes a viable solution. Combination therapy with simvastatin and fenofibrate, in various dosages, is an efficient and reliable mean of pharmacological prevention
Select Disease Character Offset Disease Term Instance
diabetes mellitus 2445 high incidence and prevalence can engender impairment in lipid control aside from alimentary intake ( diabetes mellitus [DM], hypothyroidism, HIV/AIDS, chronic kidney disease, Cushing syndrome, drugs, and alcohol abuse).[9],[10]Even
diabetes mellitus 4060 following keywords in combination: “adverse effects, cardiovascular disease, combined dyslipidemia, diabetes mellitus , dyslipidemia, fenofibrate, fenofibric acid, fibrate, mixed dyslipidemia, lipid-lowering medications,
diabetic retinopathy 16270 subjects enrolled in ACCORD Lipid was recruited for the ACCORD Eye trial, which assessed subjects with diabetic retinopathy .[60] As previously demonstrated in the FIELD,[55] fenofibrate in combination therapy showed its protective
diabetic retinopathy 35856 (0.39)Stroke98881.05 (0.8)All-cause mortality3023350.91 (0.33)Fatal or nonfatal CHD1201430.82 (0.1)OtherProgression of diabetic retinopathy 52800.6 (0.006)Moderate vision loss2272330.95 (0.57)Abbreviations: CV, cardiovascular; MI, myocardial
familial combined hyperlipidemia 31782 preferred.Childhood with CDAcquired CD is a more prevalent form of dyslipidemia in childhood.[113] Diagnosis of familial combined hyperlipidemia (FH) requires the presence of increased Apo-B and sd-LDL particles in the patient and in at least two
hyperlipidemia 31800 CDAcquired CD is a more prevalent form of dyslipidemia in childhood.[113] Diagnosis of familial combined hyperlipidemia (FH) requires the presence of increased Apo-B and sd-LDL particles in the patient and in at least two
hypertriglyceridemia 12123 fatty liver disease treatment.[48] LDL trend can show a paradoxical pattern: in fact in case of severe hypertriglyceridemia , catabolism of TG induced by fibrate can convert VLDL to LDL rapidly, leading to initial LDL elevation
hypertriglyceridemia 14563 reduction of total CVD events to 15% and a post hoc analysis reported that subgroups affected by marked hypertriglyceridemia , CD, and metabolic syndrome experienced greater benefit of fenofibrate treatment.[56] Unexpectedly,
hypothyroidism 2469 prevalence can engender impairment in lipid control aside from alimentary intake (diabetes mellitus [DM], hypothyroidism , HIV/AIDS, chronic kidney disease, Cushing syndrome, drugs, and alcohol abuse).[9],[10]Even if the use
hypothyroidism 27072 preexisting risk factors (chronic kidney disease, hepatic insufficiency, muscular disease, age, and hypothyroidism ).[88] It is generally recommended to measure ALT and CPK at the baseline and after some weeks of treatment
hypothyroidism 30840 requiring hemodialysis have been reported,[104] great caution should be paid not only in case of known hypothyroidism but also in case of occult hypothyroidism.[102],[103] Therefore, a screening of thyroid function before
hypothyroidism 30882 reported,[104] great caution should be paid not only in case of known hypothyroidism but also in case of occult hypothyroidism .[102],[103] Therefore, a screening of thyroid function before initiating double therapy is recommended.HIVHIV
metabolic syndrome 12417 in glucose control: in some studies, fenofibrate improved insulin sensitivity and glucose level in metabolic syndrome , DM2 and CD patients.[49]–[52] The underlying mechanism could be an increase of adiponectin (insulin
metabolic syndrome 14593 15% and a post hoc analysis reported that subgroups affected by marked hypertriglyceridemia, CD, and metabolic syndrome experienced greater benefit of fenofibrate treatment.[56] Unexpectedly, fenofibrate slowered glomerular
metabolic syndrome 28689 thus, any head-to-head comparison is presently unreliable.Special populations and conditionsDM and metabolic syndrome DM patients represent the target population of the ACCORD Lipid trial; therefore, such results are the
metabolic syndrome 32228 Approximately 40% of obese adolescents have an atherogenic pattern typical of individuals with DM and metabolic syndrome . Intervention of lifestyle change is primary; however, if after 6 months lipid profile has not improved
obesity 1937 factors, such as smoke, impaired metabolism of lipids and carbohydrates, hypertension, sedentary life, and obesity .[2]–[8]The role of high levels of cholesterol in atherosclerosis pathogenesis is unquestioned[5]–[8]
obesity 5488 usually associated with other dysmetabolic patterns such as insulin resistance or overt diabetes and obesity , whose essential pathological features are endothelial dysfunction and high risk of thrombosis.[15],[19]

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